RURAL–URBAN DISPARITIES IN COGNITIVE PERFORMANCE IN BRAZIL AND MEXICO

Abstract Latin America (LA) has the highest dementia burden globally among people 60 years or older, with a prevalence of 8.5%. However, there is little evidence of the disparities in cognitive performance in rural and urban areas in LA. We use nationally representative data from the two largest countries in LA, Brazil and Mexico, to assess if rurality is associated with cognitive impairment, and assess how education and country modify this relationship. The sample included 9,412 participants from the Brazilian Longitudinal Study of Aging (ELSI) and 14,779 participants from the Mexican Health and Aging Study (MHAS). Participants were classified as cognitively impaired or not impaired using cognitive performance scores and a regression-based approach. Logistic regression models were used to estimate the association between rural/urban residency and cognitive function. The modifying effect of education and country was investigated by adding an interaction term in the fully adjusted model. ELSI participants had a mean age 62.5±9.8 years, 54% were women, 13.3% were illiterate, and 6% had cognitive impairment. MHAS participants from had a mean age 64.8±9.7 years, 55% were women, 18% were illiterate, and 5% were cognitively impaired. In Mexico, those living in rural areas were more likely to have cognitive impairment than those in urban areas (OR=1.43, 95%CI=1.20;1.71), but this difference was not seen in Brazil (OR=1.10, 95%CI=0.87;1.36). The three-way interaction of rurality with country and education showed that rural residents of Mexico had lower odds of cognitive impairment compared to rural residents of Brazil with the same level of education (p<0.001).

(SHARE) and Brazilian Longitudinal Study of Aging (ELSI-Brazil).MCR was defined as the presence of cognitive complaints and slow gait with no mobility disability and dementia.Associations between demographic [sex, education], medical [hypertension, diabetes, Parkinson's, heart disease, stroke, obesity, depression, multiple falls], sensorimotor [grip strength, hearing] and behavioral factors [smoking, sedentariness, sleep quality], and prevalent MCR were examined using logistic models.Despite some overlap, cohort-specific risk factors for MCR were identified with relative risk ratios ranging as: 0.4-2.8 for education and multiple falls in HRS, for poor hearing and sedentariness in ELSA, 2.3-2.6 for poor grip and diabetes in MHAS, 1.9-2.2 for depression and sedentariness in CHARLES, 0.5-5.3 for education and stroke in LASI-DAD, 0.3-2.4 for education and depression in SHARE and 2.4-4.0 for multiple falls and stroke in ELSI-Brazil.In this cross-sectional, cross-national comparison of 21 countries, MCR associated risk factors were regionspecific, laying the foundation for tailored interventions to prevent MCR and subsequently dementia.

RURAL-URBAN DISPARITIES IN COGNITIVE PERFORMANCE IN BRAZIL AND MEXICO
Natalia Gomes Goncalves 1 , Jaqueline Avila 2 , Laiss Bertola 3 , Alejandra Obregon 4 , Cleusa Ferri 3 , Rebeca Wong 5 , and Claudia Suemoto 6 , 1. University of Sao Paulo Medical School,Sao Paulo,Sao Paulo,Brazil,2. University of Massachusetts Boston,Boston,Massachusetts,United States,3. Federal University of Sao Paulo,Sao Paulo,Sao Paulo,Brazil,4. University of Texas Medical Branch,Galveston,Texas,United States,5. UTMB,Galveston,Texas,United States,6. Universidade de São Paulo,São Paulo,Sao Paulo,Brazil Latin America (LA) has the highest dementia burden globally among people 60 years or older, with a prevalence of 8.5%.However, there is little evidence of the disparities in cognitive performance in rural and urban areas in LA.We use nationally representative data from the two largest countries in LA, Brazil and Mexico, to assess if rurality is associated with cognitive impairment, and assess how education and country modify this relationship.The sample included 9,412 participants from the Brazilian Longitudinal Study of Aging (ELSI) and 14,779 participants from the Mexican Health and Aging Study (MHAS).Participants were classified as cognitively impaired or not impaired using cognitive performance scores and a regression-based approach.Logistic regression models were used to estimate the association between rural/urban residency and cognitive function.The modifying effect of education and country was investigated by adding an interaction term in the fully adjusted model.ELSI participants had a mean age 62.5±9.8 years, 54% were women, 13.3% were illiterate, and 6% had cognitive impairment.MHAS participants from had a mean age 64.8±9.7 years, 55% were women, 18% were illiterate, and 5% were cognitively impaired.In Mexico, those living in rural areas were more likely to have cognitive impairment than those in urban areas (OR=1.43,95%CI=1.20;1.71),but this difference was not seen in Brazil (OR=1.10,95%CI=0.87;1.36).The three-way interaction of rurality with country and education showed that rural residents of Mexico had lower odds of cognitive impairment compared to rural residents of Brazil with the same level of education (p<0.001).

A CROSS-COUNTRY ANALYSIS OF COGNITION AND ASSOCIATED RISK FACTORS
David Knapp, Arie Kapteyn, Alessandro Giambrone, and Tabasa Ozawa, University of Southern California, Los Angeles, California, United States The widely cited Lancet Commission (Livingston et al., 2017) concluded that a third of dementia cases may be preventable through appropriate interventions targeting what they refer to as modifiable risk factors.These risk factors have been widely studied individually, but rarely investigated collectively and across many countries.We analyze the cross-country consistency of relationships between these modifiable risk factors and cognition using an internationally comparable set of aging studies in 31 countries including the United States, England and Europe.Cross-country differences in culture, policies, economy, and other collective experiences lead to significant variation in lifecycle outcomes, including dementia onset and modifiable risk factors.We find a limited number of robust relations: education, depression, and hearing show clear, consistent associations with our cognition measure, the sum of immediate and delayed recall.The evidence for other factors, including obesity, smoking, diabetes, and hypertension is weaker and becomes almost non-existent when correcting for multiple hypotheses testing.The inconsistent relationship across countries between these risk factors and cognition suggests the lack of a causal mechanism leading to cognitive decline -a necessary condition for these risk factors to be modifiable and effective targets for policy interventions aimed at controlling the prevalence and cost of dementia.

CROSS-COUNTRY VALIDATION OF ANTHROPOMETRIC AGE (ANTHROPOAGE) AS A MEASURE OF BIOLOGICAL AGING
Carlos Fermin-Martinez 1 , Omar Yaxmehen Bello-Chavolla 2 , Neftali Antonio-Villa 3 , Luisa Fernandez-Chirino 4 , and Daniel Ramirez-Garcia 5 , 1. School of Medicine, National Autonomous University of México (UNAM), Mexico City,Distrito Federal,Mexico,2. Instituto Nacional de Geriatría,Mexico City,Distrito Federal,Mexico,3. Instituto Nacional de Cardiologia Ignacio Chavez,Mexico City,Distrito Federal,Mexico,4. Instituto Nacional de Geriatria,Mexico City,Distrito Federal,Mexico,5. Facultad de Medicina,Universidad Nacional Autonoma de Mexico,Mexico City,Distrito Federal,Mexico Aging occurs at unique rates at an individual and population-level.In contrast to chronological age (CA), biological age (BA) is better at capturing functional decline and risk of age-related diseases, disability, and death.Nonetheless, it is still unclear how this phenomenon changes across adults from different races/ethnicities.We recently developed a BA metric using anthropometric measurements (AnthropoAge) in participants from NHANES-III.Here, we aim to validate AnthropoAge across countries and to determine whether it displays population-specific patterns using harmonized cohorts from the U.S. and Mexico from the Gateway to Global Aging Data Team, including the Mexican Health and Aging Study and the Health and Retirement Study.We found that AnthropoAge is a robust predictor of overall mortality risk in both American (AUROC=0.797;95%CI 0.786-0.808)and Mexican (0.776; 0.740-0.812)adults, and this was consistent across multiple cutoffs of time.Notably, we found that the prediction improved in participants aged 50-75 years in comparison to older adults aged 75-100 years.AnthropoAge was also associated with number of comorbidities and disability in activities of daily living independently of CA.Finally, we observed marked changes of AnthropoAge and its acceleration across the years in both countries, with a significant interaction with Mexican ethnicity (beta for interaction: 0.2034; p=5.94E-05).AnthropoAge is a robust and reproducible measure of BA, however, new studies are required to decipher the heterogeneity of anthropometric aging in specific ethnicities and age categories.

PUBLISHING ON A GLOBAL SCALE IN GERONTOLOGY: A VIEW FROM THE EDITORS' DESKS
Chair: Edward Miller Co-Chair: Elizabeth Simpson Discussant: Nicholas Castle Global aging has proceeded at an unprecedented and accelerating rate.The aging of the population creates both opportunities and challenges for older adults, their families, and society.Importantly, there is substantial variation in the effects of and response to global aging both within and across nations depending, in part, on prevailing cultural expectations and values, political and economic imperatives, and social and demographic characteristics.Thus, while some regions and countries have responded with innovative policies and programs to better enable the growing cohort of older adults to remain active and engaged in the community, other regions and countries have struggled with their response or barely begun to plan for the rising population of older adults.This symposium assembles editors at five leading gerontological journals to demonstrate the role that peer-reviewed scholarship can play in disseminating knowledge that informs gerontological research, policy, and practice internationally.The editors include: Edward Alan Miller, PhD, Journal of Aging & Social Policy; Kyungmin Kim, PhD, Research on Aging; Julie Robison, PhD and Debra Dobbs, PhD, Journal of Applied Gerontology; Julie Patrick, PhD, International Journal of Aging and Human Development; and Sandra Torres, PhD, Ageing & Society.Each presenter will review the scope, content, and focus of their journals and the role and opportunities for international scholarship.Nicholas Castle, PhD, International Editor at The Gerontologist, will serve as discussant.

INTERNATIONAL PUBLISHING OPPORTUNITIES AT THE JOURNAL OF AGING & SOCIAL POLICY
Edward Miller 1 , Elizabeth Simpson 1 , Michael Gusmano 2 , and Pamela Nadash 1 , 1. University of Massachusetts